Costs of smoking among active duty U.S. Air Force personnel--United States, 1997

Smoking is the leading cause of preventable disease and death in the United States (1). The health consequences of smoking impose a substantial economic toll on persons, employers, and society. Smoking accounts for $50-$73 billion in annual medical-care expenditures, or 6%-12% of all U.S. medical costs (2-5). The costs associated with lost productivity also are extensive (2). In 1997, approximately 25% of male and 27% of female active duty Air Force (ADAF) personnel aged 17-64 years were smokers (6). A 1997 retrospective cohort study was conducted among ADAF personnel to estimate the short-term medical and lost productivity costs of current smoking to the U.S. Air Force (USAF). This report summarizes the results of the study, which indicate that current smoking costs the USAF approximately $107.2 million per year: $20 million from medical-care expenditures and $87 million from lost workdays.     

Suicide trends and characteristics among persons in the Guaraní Kaiowá and Nandeva communities--Mato Grosso do Sul, Brazil, 2000-2005

Suicide rates among indigenous communities around the world vary substantially; in many nations these groups have the highest suicide risk of any identifiable cultural or ethnic group. Mato Grosso do Sul is a state in the southwest corner of Brazil that borders Bolivia and Paraguay. In 2004, the Guaraní, an indigenous ethnic group in the region, accounted for 2.6% of Mato Grosso do Sul's population (approximately 2,230,702). During 1975-2000, the infant mortality rate decreased, and overall life expectancy increased in Mato Grosso do Sul; however, suicide increased as a proportion of overall mortality among the Kaiowá and Nandeva communities of the Guaraní population. In 2000, the National Health Foundation (FUNASA) of the Brazilian Ministry of Health (BMH) initiated a study of suicide trends and characteristics in these two Guaraní communities; data were collected during 2000-2005, and epidemiologic assistance was provided by CDC. This report summarizes the results of that study, which suggested that the suicide rate among Guaraní was 19 times higher than the national rate in Brazil and 10 times higher than the rate in Mato Grosso do Sul and that suicides disproportionately affected Guaraní adolescents and young adults. To decrease suicide rates, BMH initiated research and prevention programs among the Guaraní, and the Guaraní initiated measures to increase their economic self-sufficiency.     

Deaths among members of the Public Health Service Commissioned Corps, 1965-89.

The U.S. Public Health Service Commissioned Corps performs health promotion and disease prevention activities and provides clinical care. The authors examined the epidemiology of deaths among active duty personnel and the hypothesis that, based on the mission, mortality would be less than in the general population, and that deaths would reflect nonpreventable causes. A retrospective record review for the period 1965-89 showed 118 active duty deaths, 26 percent of the number anticipated in a general population group adjusted for age, sex, and race or ethnicity. The five major causes of death were coronary heart disease, suicide, motor vehicle crash, malignant neoplasm, and drowning. Beginning with the mid-1980s, infectious disease became a principal cause of death, the only cause for which the rate trended upward. Among professionals, death rates were highest among sanitarians and veterinarians, and lowest among pharmacists. The only causes for which deaths exceeded the expected number involved suicides and possibly deaths related to acquired immunodeficiency syndrome. Active duty status in the Commissioned Corps was associated with a death rate less than that of comparable groups in the general population. Many of the premature deaths were attributable to preventable causes.     

Comparison of weight status among two cohorts of US Air Force recruits

BACKGROUND: Overweight and obesity are increasing rapidly in the US and the Department of Defense (DoD). We examined whether weight trends evidenced in the general population and DoD are occurring among individuals entering US Air Force (USAF) Basic Military Training (BMT). METHODS: Individuals entering the USAF in 1996 (AF1996; N = 29,036) and 2000 (AF2000; N = 31,080), ages 17-29 years were surveyed. The two recruit cohorts were compared to age-matched individuals from the 1996 (N = 22,153) and 2000 (N = 31,861) Behavioral Risk Factor Surveillance System Survey (BRFSS). RESULTS: Crude rates for all age groups and age- and gender-standardized prevalence rates reflected significant increases in overweight/obesity among recruits. The direct standardized prevalence of overweight/obesity increased nearly 24%, from 14.8% in AF1996 to 18.3% in AF2000. The increase in overweight/obesity was particularly large among male recruits ages 25-29 (i.e., from 36.4% to 44.5%) between 1996 and 2000. CONCLUSIONS: USAF cohorts were less likely to be overweight than corresponding BRFSS samples. There were 19.1 and 20.2 percentage point differences between overall crude rates of overweight/obesity between AF1996 and BRFSS 1996 and AF2000 and BRFSS 2000, respectively. Nevertheless, overall rates of overweight and obesity are increasing among young recruits in the USAF at a fairly marked rate (approximately one percentage point per year).     

Viral hepatitis in the US Navy, 1975-1984

The epidemiology of viral hepatitis in US Navy enlisted personnel was reviewed for the years 1975-1984. Hospital discharge summaries of all active duty enlisted personnel admitted to a US Navy treatment facility were used for the study. From 1975 to 1984, total first hospitalizations for viral hepatitis declined from 128 per 100,000 personnel (95% confidence interval (Cl) 118-139) to 56 per 100,000 personnel (95% Cl 50-63). The highest incidence of acute viral hepatitis (115 per 100,000 personnel) was found in the youngest age groups aged 24 years and less. Risk factors for acute hepatitis included a previous hospitalization with either drug abuse (relative risk = 363) or a sexually transmitted disease (relative risk = 25) listed among the discharge diagnoses. Having a medical job classification was also associated with an increased risk of acute hepatitis. The steep decline in the incidence of viral hepatitis during this 10-year period may have been due to decreasing drug abuse in the US Navy. Immunization of high-risk groups in the US Navy with hepatitis B vaccine could be an effective policy for the prevention of acute viral hepatitis.     

Cluster and regional influences on suicide in a Southwestern American Indian tribe

Suicide is the second leading cause of death among American Indian youth. Elevated rates of suicide in Indian communities have been attributed both to outbreaks and to regional trends. We assessed the contribution of these two factors for a single tribe, and attempted to define a profile of individuals at risk. Data came from the tribe's registry of suicide attempts and completions for 1990-1993 and analysis of death certificates for the period 1985-1996. Using combined tribal and death certificate data, the average annual (age-adjusted) rate of completed suicide among tribal members was 44.7/100,000 for 1990-1993. Within the 45 suicide deaths and serious attempts in this time period, we identified one grouping of seven cases taking place in a 40-day period. All seven involved hanging and youth (13-28 years old). Using death certificate data alone, the average annual rate of suicide death for non-natives in the surrounding county in the period 1985-1996 was 22.7/100,000. Age-adjusted to the county population, the tribal rate for the same period was not significantly different (24.6/100,000). Tribal and county suicide patterns differed by age distribution and method but not by gender. We concluded that both regional trends and clustering contribute to suicide in this community. Further prevention efforts may need to focus on both unique tribal characteristics and shared factors among non-native neighbors.     

Suicide among Hispanics--United States, 1997-2001

By 2020, Hispanics are expected to represent 17% of the U.S. population and to surpass all other racial/ethnic minority populations in size. In 1996, the U.S. Department of Health and Human Services established the Hispanic Agenda for Action initiative; a major goal of this initiative is to identify health problems that affect Hispanics. In 2001, although the overall age-adjusted suicide rate per 100,000 population among Hispanics was lower than the U.S. national rate (10.7), suicide was the third leading cause of death among young (i.e., aged 10-24 years) Hispanics and the seventh leading cause of years of potential life lost before age 75 years. To identify demographic groups at risk for suicide and to help guide prevention efforts, CDC analyzed mortality data for 1997-2001. This report summarizes the results of that analysis, which indicated that, among Hispanics, the largest proportion of suicides occurred among young persons; suicide rates were higher among males; and the most common method of suicide was by firearms. To reduce the number of suicides, additional prevention strategies are needed, including 1) improving methods for collecting data about suicides, suicide attempts, and related behaviors; 2) expanding evaluation of prevention efforts aimed at reducing suicidal behaviors; and 3) examining how effective interventions can be modified for diverse and culturally specific populations.     

A correlation between increases in suicide rates and increases in male unemployment rates in Mie prefecture, Japan

The number of suicides in Japan has increased from approximately 22,000 per year in 1988-1997 to over 30,000 per year since then. It has also increased in Mie prefecture during that period. In the present study, we investigated the correlation between annual suicide rates in Mie prefecture, Japan from 1996-2002 and the annual unemployment rate in Japan from 1996-2002 among males. Among the results, annual suicide rates in total correlated with the unemployment rate in Japan, but the relation was not statistically significant: r(7)=0.76, r(2)(7)=0.58, p=0.05 (y=3.54x+6.37); the rates in males, however, correlated significantly with the unemployment rate in Japan: r(7)=0.85, r(2)(7)=0.73, p=0.01 (y=5.72x+4.49). In addition, we found that annual suicide rates in total correlated significantly with the male unemployment rates. When a patient is unemployed and in a bad situation, the medical staff and the family should be aware of the correspondence between suicide rates and unemployment.     

医学生自杀倾向与性相关行为影响因素分析

目的了解医学生的自杀倾向发生状况,探讨自杀倾向与性相关行为的相互影响。方法采用分层整群随机抽样方法,问卷调查1466名1～5年级医学本科生的自杀、性相关行为等35项相关因素及行为现状,进行一般描述性分析和非条件Logistic回归分析。结果医学生自杀倾向发生率15.96%;不同年级间自杀倾向发生率有差别,高年级发生率高于低年级;独生子女的发生率高于非独生子女;多因素Logistic回归分析显示,自杀倾向与经常怨天尤人、被告知患性病、打架行为、看黄色书刊影像、异性性行为、自慰行为、使用违禁药品、通宵上网游戏、控制体重、睡眠异常、缺少锻炼、找心理医生等12项因素和性相关行为有联系,OR值分别为3.247,1.868,1.736,1.671,1.566,1.542,1.530,1.478,1.425,1.401,1.351,1.321。结论医学生自杀倾向发生率较高,性相关行为是自杀倾向的重要危险因素,自杀倾向与性相关行为相互影响,必须采取针对性措施对自杀倾向实施干预。     

Methods of suicide among persons aged 10-19 years--United States, 1992-2001

In 2001, suicide was the third leading cause of death among persons aged 10-19 years. The most common method of suicide in this age group was by firearm (49%), followed by suffocation (mostly hanging) (38%) and poisoning (7%). During 1992-2001, although the overall suicide rate among persons aged 10-19 years declined from 6.2 to 4.6 per 100,000 population, methods of suicide changed substantially. To characterize trends in suicide methods among persons in this age group, CDC analyzed data for persons living in the United States during 1992-2001. This report summarizes the results of that analysis, which indicated a substantial decline in suicides by firearm and an increase in suicides by suffocation in persons aged 10-14 and 15-19 years. Beginning in 1997, among persons aged 10-14 years, suffocation surpassed firearms as the most common suicide method. The decline in firearm suicides combined with the increase in suicides by suffocation suggests that changes have occurred in suicidal behavior among youths during the preceding decade. Public health officials should develop intervention strategies that address the challenges posed by these changes, including programs that integrate monitoring systems, etiologic research, and comprehensive prevention activities.     

非现役文职人员军事素质的养成

目的探讨非现役文职人员参加野外驻训对其军事素质养成的意义。方法经过科学抽组,选出工作四年以上、年度综合素质考评优秀的非现役文职人员整编到现役队伍中。通过在院内进行为期一月的野战救护综合素质训练,再整体开往野外作训场地,进行为期一月的野战模拟救护培训。结果通过严格组训,科学施训,强化了非现役文职人员的业务素质、军事素质和实战救治能力。结论非现役文职人员参加野外驻训,对其军事素质的养成有积极的推动作用,是医院在现役军人比例下降的趋势下,保证部队医院为兵服务属性不变,提高医院卫勤保障水平的有效手段。     

A retrospective cohort mortality study of Italian commercial airline cockpit crew and cabin attendants, 1965-96

A retrospective cohort mortality study was conducted among Italian commercial flight personnel for the period 1965-1996. The cohort was composed of 3,022 male cockpit crew members and 3,418 male and 3,428 female cabin attendants. Cause-specific standardized mortality ratios (SMRs) and exact 95% confidence intervals (CIs) were calculated as estimates of the relative risk. Mortality from all cancers was less than expected for all categories (SMRs of 0.58 for male cockpit crew, 0.67 for male cabin attendants, and 0.90 for female cabin attendants). Among male flight personnel, the SMR for leukemia was somewhat elevated (SMR 1.73; 95% CI: 0.75-3.41) based on eight deaths, with a positive trend by length of employment (p = 0.046). Additionally, an excess of death by suicide was seen among female cabin attendants (SMR 3.38; 95% CI: 1.24-7.35). Other Italian studies of flight personnel are under way, including a detailed assessment of cosmic radiation exposure and investigations of non-radiation occupational risk factors and prevalence of nonfatal outcomes.     

Human immunodeficiency virus seropositivity among members of the active duty US Army 1985-89.

Between October 1985 and June 1989, most active duty US Army soldiers were screened for human immunodeficiency virus (HIV) antibody. Of 648,032 screened soldiers in this analysis, 1,588 were HIV-antibody positive. In a multivariate analysis, correlates of positivity included: age [Adjusted Odds Ratios (ref less than 20 years) = 20-24 years, 3.7; 25-29, 9.3; 30-34, 15.7; greater than or equal to 35, 15.9]; being male, [4.2]; being Black or Hispanic (vs white) [3.7 and 3.0, respectively]; being single (vs married) [3.8]; assignment to an HIV endemic location [1.7], and having a medical occupation [2.7, 2.7, and 2.6 for negligible, low, and high blood exposure professions, respectively]. Seropositivity rate ratios for medical vs non-medical personnel were 0.7 [95% CI = 0.4, 1.4] for females and 2.9 [95% CI = 2.5, 3.3] for males. For male medical personnel, being single (vs married) correlated strongly with antibody positivity [prevalence ratio = 3.4, 95% CI = 2.6, 4.6]. Excess HIV risk among medical personnel appeared largely attributable to factors other than occupational exposures.     

Traumatic deaths during U.S. Armed Forces basic training, 1977-2001

BACKGROUND: A Recruit Mortality Registry, linked to the Department of Defense Medical Mortality Registry, was created to provide comprehensive medical surveillance data for deaths occurring during enlisted basic military training. METHODS: Recruit deaths from 1977 through 2001 were identified and confirmed through redundant sources. Complete demographic, circumstantial, and medical information was sought for each case and recorded on an abstraction form. Mortality rates per 100,000 recruit-years were calculated by using recruit accession data from the Defense Manpower Data Center. RESULTS: There were 276 recruit deaths from 1977 through 2001 and age-specific recruit mortality rates were less than half of same-age U.S. civilian mortality rates. Only 28% (77 of 276) of recruit deaths were classified as traumatic (suicide, unintentional injury, and homicide), in comparison to three quarters in both the overall active duty military population and the U.S. civilian population (ages 15-34 years). The age-adjusted traumatic death rates were highest in the Army (four times higher than the Navy and Air Force, and 80% higher than the Marine Corps). The majority (60%) of traumatic deaths was due to suicide, followed by unintentional injuries (35%), and homicide (5%). The overall age-adjusted traumatic mortality rate was more than triple for men compared with women in all military services (rate ratio=3.9; p=0.01). CONCLUSIONS: There was a lower proportion of traumatic deaths in recruits compared to the overall active duty military population and same-age U.S. civilian population. This finding could be attributed to close supervision, emphasis on safety, and lack of access to alcohol and motor vehicles during recruit training.     

Suicide in the French Armed Forces

Several states, of whom France, have been alarmed about suicide in the military. An observational longitudinal cohort study was conducted to check whether the suicide risk in the French army was higher than in the general population and to find out the more prone to self-harm destruction personnel categories. From 1997 to 2000 inclusive, 230 suicides occurred among 315,934 person.years; i.e., the overall annual crude suicide rate was 18.2 per 100,000 active-duty personnel. With the National data for 1999 as reference, army men had a lower suicide risk than men in the overall population of similar age categories (standardised mortality ratio = 67). A Poisson regression model showed that the incidence rate in the Gendarmerie was twice as high as in the Land Forces (incidence rate ratio = 2.15), that the incidence relative risk increased threefold over 4 years, and that the incidence rate ratio amongst under 25 and from 40 to 44-year-old personnel was almost twice as high as in the 25-29-year-old category. The main suicide methods were use of a firearm (51%) and hanging (28%). Despite a global lower risk than in the general population, certain army categories, i.e., Gendarmerie personnel and young men, deserve specific surveillance and preventive measures.     

医学生自杀态度及影响因素调查

目的了解医学生的自杀态度以及影响因素，为自杀预防的健康教育工作提供资料。方法以整群抽样方法抽取某医科大学一年级、三年级本科学生，应用自杀态度问卷（QSA）进行调查。结果医学生对自杀总的态度（F）、对自杀性质的认识（F1）持矛盾或中立的态度，对自杀者（F2）、自杀者家属（F3）以及安乐死（F4）持理解或宽容的态度。65．9％的医学生表示需要预防自杀的知识和技巧。结论对医学生进行系统的自杀干预知识和技巧的培训是很有必要的。     

Suicidal Thoughts and Attempts Among U.S. High School Students: Trends and Associated Health-Risk Behaviors, 1991–2011

PurposeTo describe secular trends in suicidal thoughts and attempts and the types of health-risk behaviors associated with suicidal thoughts and attempts among U.S. high school students.MethodsData were analyzed from 11 national Youth Risk Behavior Surveys conducted biennially during 1991–2011. Each survey employed a nationally representative sample of students in grades 9–12 and provided data from approximately 14,000 students. Using sex-stratified logistic regression models that controlled for race/ethnicity and grade, we analyzed secular trends in the prevalence of suicidal thoughts and attempts. Adjusted prevalence ratios (APR) were calculated to measure associations between suicide risk and a broad range of health-risk behaviors.ResultsDuring 1991–2011, among female students, both suicidal thoughts (seriously considered suicide; made a plan to attempt suicide) and attempts (any attempt; attempt with injury requiring medical treatment) decreased significantly; among male students, only suicidal thoughts decreased significantly. During 2011, compared with students with no suicidal thoughts or attempts, the health-risk behaviors most strongly associated with suicide attempts among female students were injection drug use (APR = 12.8), carrying a weapon on school property (APR = 9.7), and methamphetamine use (APR = 8.7); among male students, the strongest associations were for IDU (APR = 22.4), using vomiting/laxatives for weight control (APR = 17.1), and having been forced to have sex (APR = 14.8).ConclusionsSchool-based suicide prevention programs should consider confidential screening for health-risk behaviors that are strongly associated with suicide attempts to help identify students at increased risk for suicide and provide referrals to suicide and other prevention services (e.g., substance abuse and violence prevention) as appropriate.     

疫情防控期间上海市中心城区社区医务人员职业倦怠状况及影响因素分析

  目的  掌握新型冠状病毒肺炎疫情期间社区医务人员职业倦怠情况和影响因素,提升医务人员心理健康水平。
  方法  随机选取上海市某中心城区社区医务人员843人,开展面对面问卷调查,采用工作内容内卷(JCQ)、付出-回报失衡(ERI)问卷调查医务人员职业紧张情况,采用工作倦怠感量表(MBI)调查职业倦怠情况。采用logistic回归方法分析职业倦怠的影响因素。
  结果  回收有效问卷835份,有效应答率99.1%。JCQ模式下,835名社区医务人员职业紧张检出率为42.5%,ERI模式下,职业紧张检出率为34.0%。职业倦怠发生率为50.8%,其中轻、中度职业倦怠发生率为42.2%,重度职业倦怠发生率为8.6%。logistic回归分析结果显示:分别相比年龄 < 30岁、工龄 < 10年、临床科室、每周工作时长 < 40 h、不值夜班,年龄40 ~ 49岁(OR = 1.546)、工龄≥ 10年(OR = 1.506 ~ 1.707)、公共卫生科室(OR = 2.085)、每周工作时长≥ 50 h(OR = 2.408)、值夜班(OR =1.811)的社区医务人员发生职业倦怠的风险增加(P < 0.05);相比月收入 < 3 000元、不运动、每天睡眠时间 < 6 h的人员,月收入≥ 3 000元(OR = 0.098 ~ 0.133)、每周锻炼次数≥1次(OR = 0.308 ~ 0.603)、每天睡眠时间≥ 6 h(OR = 0.300 ~ 0.334)的人员发生职业倦怠的风险降低(P < 0.05);社会支持(OR = 0.667)、回报(OR = 0.605)的得分越高,社区医务人员发生职业倦怠的风险越小(P < 0.05);付出(OR = 2.468)、内在投入(OR = 1.549)的得分越高,社区医务人员发生职业倦怠的风险也越大(P < 0.05)。
  结论  疫情防控期间,社区医务人员存在一定程度的职业倦怠情况。可从个体、组织、社会三方面加强干预,通过提升业务技能水平、合理排班作息、适度运动锻炼、加强心理疏导等途径方式,降低社区医务人员职业倦怠。
     

Five-year prospective study of tuberculin skin testing among new healthcare personnel at a university hospital in Thailand

We determined the prevalence of a positive tuberculin skin test (TST) and the incidence of TST conversion among new healthcare personnel (HCP) in a hospital in Thailand. During 2005-2008, TST was performed on 1438 HCP and the prevalence of positive TST was 66.3%. Age, male gender, and the presence of Bacille Calmette-Guérin (BCG) scar were associated with odds of positive TST (all P < 0.05). The incidence of TST conversion was 4.8 per 100 HCP-years. Nine (0.6%) HCP were diagnosed with active tuberculosis. The annual surveillance programme is important for the early diagnosis and prevention of tuberculosis among HCP in Thailand.     

Jurisdictional trends in opioid overdose deaths, 1988–96

This report analysed data on opioid overdose mortality between 1988 and 1996 to:

• • examine differences between jurisdictions in the rate of fatal opioid overdose and the rate of increase in overdose; and

• • estimate the proportion of all deaths which were attributed to opioid overdose.

Australian Bureau of Statistics (ABS) data were obtained on the number of deaths attributed to opioid dependence (ICD 9 codes 304.0, 304.7) and accidental opioid poisoning (ICD 9 codes E850.0, E850.1). The highest rate of fatal overdose occurred in NSW, followed by Victoria. The standardised mortality rate among other jurisdictions fluctuated quite markedly. While the rate of opioid overdose has increased throughout Australia, the rate of increase has been greater in some of the less-populous states and territories than it has in NSW or Victoria.
In 1996, approximately 6.5% of all deaths among people aged 15–24 years and approximately 10% of all deaths among those aged 25–34 were due to opioid overdose. During the interval from 1988 to 1996, the proportion of deaths attributed to opioid overdose increased. From 1988 to 1996, the proportion of deaths attributed to opioid overdose among individuals aged 25–34 years was approximately one-third that attributed to suicide, but this proportion had increased to approximately one-half by 1996. The rate of increase in the proportion of deaths attributed to opioid overdose was higher than the rate of increase in the proportion of deaths attributed to suicide.